Washington, D.C., June 29 - Constitutional law and health law and policy experts convened at American University Washington College of Law Thursday to analyze the U.S. Supreme Court's landmark decision to uphold the Affordable Care Act (ACA).

The United States Supreme Court handed down their ruling on the health care law Thursday morning, upholding the Affordable Care Act in its entirety—including the individual mandate, under Congress' taxing authority.

The panel, "Analyzing the Supreme Court's Health Reform Decision," was held only hours after the release of the nearly 200 pages of opinions, and featured the commentary of faculty from the law school and American University.

Speakers included:

Alan Goldberg, adjunct faculty, American University Washington College of Law

Lewis Grossman, professor of law, American University Washington College of Law

Taryn Morrissey, professor of public administration, School of Public Affairs, American University

Daniel Marcus, fellow in law and government, American University Washington College of Law

William Yeomans, fellow in law and government, American University Washington College of Law

Stephen Wermiel, fellow in law and government; associate director, Summer Institute on Law and Government, American University Washington College of Law

Lindsay Wiley, assistant professor of law; faculty director, Health Law and Justice Program, American University Washington College of Law

The panel discussion began with an overview of the Court's decision by Professor Stephen Wermiel, director of the law school's Summer Institute on Law and Government.

"First, what the court has done is uphold the individual mandate by a 5 to 4 vote, but as a proper exercise of Congress' taxing power, not a proper exercise of Congress' commerce power," explained Wermiel to more than 100 students, staff, faculty, and community members in attendance.

"I wasn't that surprised that one or more justices relied on the taxing power rather than the Commerce Clause power," said Professor Daniel Marcus. "The Commerce Clause argument didn't go well for the government in court, and Roberts and Kennedy both seemed skeptical of it at the time. "

In the second part of the decision, the court ruled that Congress has the power to expand the Medicaid program, but does not have the power to force that expansion by threatening states with the loss of existing Medicaid funding if they decide not to comply.

According to health law and policy expert Professor Lindsay Wiley (pictured right), many receive federal assistance, or subsidies, under ACA to help them afford private insurance. However, those subsidies only go into effect for people living at or above 133% of the federal poverty level (income above $14,856 for single person). The Medicaid expansion is meant to care for the population below that line.

"If states don't now take advantage of what the Court has made a voluntary expansion of Medicaid through this ruling, then there is a group of people that could fall through the cracks of the ACA because the subsidies for private insurance wouldn't kick in," said Wiley.

Those with incomes under 133% of the federal poverty line—a lot of low income individuals—may not have access to health insurance or medical care if states waive expansion.

"I think it's a real possibility that states won't expand their Medicaid programs," added Professor Taryn Morrissey. "I think that the same states that brought the lawsuit will be very resistant in establishing exchanges and expanding their Medicaid programs."

However, Morrissey predicts that most states will choose expansion because of the lobbying power of hospitals.

Many of the panelists also addressed Chief Justice John Roberts' motivation for siding with the court's four traditionally liberal justices – Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor — to form the 5-4 majority and author the opinion.

"I think he wanted to write an opinion for the court on these issues and set forth his views on the Commerce Clause—and I think he worries, like the 4 dissenting conservatives do, about the slippery slope, or lack of the limiting principle," said Daniel Marcus.

According to Goldberg, the Supreme Court can usually be relied upon to make predictable decisions. However, because part of this decision dealt closely with the "life and death" realities of Medicare populations, Goldberg says that the "politics overwhelmed."